The Germanwings Crash:  Flying Under the Influence

On March 24, 2015, a twenty-seven-year-old German pilot named Andreas Lubitz flew an Airbus A 320 into a French mountainside, killing himself and the 149 other people on board.  Mr. Lubitz was co-piloting the flight, and he caused the aircraft to crash by locking the pilot out of the flight deck and setting the autopilot to descend to 100 feet.

During the descent, he was contacted by civilian and military traffic controllers, and by the crew of another aircraft, but he made no response.  He also ignored repeated and increasingly urgent requests from the captain to be readmitted to the flight deck.

In an earlier flight on the same day, Mr. Lubitz had set the autopilot to descend from 35,000 feet to 100 feet, and returned it to the original setting after three seconds.  Investigators suggested that this earlier maneuver may have been a rehearsal for the subsequent murder/suicide.

Investigation Report

The crash was investigated by the French Bureau d’Enquêtes et d’Analyses (BEA), who issued their final report on March 13, 2016.  Here are some of the findings from this report.

Mr. Lubitz had become depressed in August 2008 and had received psychiatric treatment, including psychiatric drugs, between November 2008 and July 2009.

Mr. Lubitz had been rated “above standard” on professionalism and skill by his instructors and examiners.

Mr. Lubitz’s private physicians refused to be interviewed by the BEA.

On February 24, 2015, four weeks before the murder/suicide, Mr. Lubitz received his first prescription of mirtazapine from his psychiatrist.  Mirtazapine, which is marketed in the US as Remeron, is an antidepressant with serotonergic activity.  Adverse effects include suicide risk, apathy, and aggression (RxList).  In the US, mirtazapine carries a suicide risk black box warning.

On March 16, 2015, eight days before the murder/suicide, Mr. Lubitz received further prescriptions of Escitalopram, Dominal, and Zolpidem from his psychiatrist.  Escitalopram, which is marketed in the US as Lexapro, is an SSRI antidepressant, and also carries a suicide black box warning.  Dominal (prothipendyl) is described as having a weak anti-psychotic potency (Wikipedia, translation from German), and is used to reduce restlessness and agitation.  Zolpidem (marketed as Ambien) is a sleeping pill.

In an email sent to his psychiatrist in March 2015, Mr. Lubitz stated that he had taken additional drugs:  Mirtazapine (15mg) and Lorazepam (1 mg).

Toxicological examination of the co-pilot’s human tissue found at the crash site detected the presence of citalopram and mirtazapine (both anti-depressants), and zopiclone (a sleeping pill).

Expressions of Concern

Since the publication of the BEA Final Report, concerns have been expressed by various individuals and groups, including bereaved relatives of the victims.  In general, these concerns have focused on the following issues:

  • That Lufthansa (the parent airline) should have done more to protect their customers.
  • That because of medical confidentiality, Mr. Lubitz was able to hide his depression and his use of antidepressant drugs from his employer.
  • That several of the doctors involved in Mr. Lubitz’s care refused to provide information to the BEA investigators.
  • That Mr. Lubitz had managed to keep his pilot’s license, despite his history with depression and psychiatric drugs.

But there has been relatively little attention focused on what is, at least in my view, the most glaring and pertinent aspect of the matter:

That Mr. Lubitz was flying a commercial aircraft under the influence of powerful psychiatric drugs that have long been associated with murder/suicides.

Links Between Murder/Suicide and Serotonin Disruptor Drugs

On September 14, 1989, a few weeks after he had started taking Prozac (the first SSRI), Joseph Wesbecker, of Louisville, Kentucky, went on a rampage at his place of employment, killing eight and wounding twelve others, before taking his own life.  Eli Lilly, the makers of Prozac, settled the subsequent litigation for an undisclosed sum that was said to be “mind boggling” (Joseph Glenmullen, Prozac Backlash, 2000, p. 176).  In the interim years, there have been numerous similar incidents.

It is now 36 years since Drs. Teicher, Glod, and Cole wrote:

“Six depressed patients free of recent serious suicidal ideation developed intense, violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment. This state persisted for as little as 3 days to as long as 3 months after discontinuation of fluoxetine. None of these patients had ever experienced a similar state during treatment with any other psychotropic drug.” American Journal of Psychiatry, 1990. [Fluoxetine, marketed as Prozac, is an SSRI]

Over the next two years, similar reports appeared in the New England Journal of Medicine, Journal of the American Academy of Child and Adolescent Psychiatry (here) and (here), Journal of Family Practice, American Journal of Psychiatry (here) and (here), Archives of General Psychiatry, Human Psychopharmacology, and the Lancet.

And similar tragic incidents have occurred with more recent drugs that tamper with the brain’s serotonin systems.

Nevertheless, psychiatry, to its eternal shame, has made no attempt to study definitively the role that psychiatric drugs play in these matters.  Instead, there has been spin:  more “treatment” is needed for “mental illness”; these drugs are safe when “properly prescribed”; the benefits outweigh the risks; etc…

It was even stated, by Connecticut Assistant Attorney General, Patrick B. Kwanashie, in the wake of the Sandy Hook murders/suicide that it would not be wise to divulge the drugs found in the shooter’s post-mortem examination, for fear that it would “… cause a lot of people to stop taking their medications.”

Even the horrific events of March 24, 2015, in the French Alps have been insufficient to jar psychiatry from its sordidly self-serving, guild-defensive silence into something resembling common decency.  It took ten minutes for the Airbus to descend from 38,000 feet to its crash site on a French mountain; ten minutes of indescribable terror for 149 innocent men, women, and children.  It is time – indeed it is long past time – for psychiatry to acknowledge the role that these pills are playing in these tragedies, to conduct a definitive study of this matter, and to publicize the problem honestly and prominently.

. . . . . . . . . . . . . . . .

On February 26, 2016, David Jolly, a member of the US House from Florida’s 13th District, introduced a bill directing the Department of Veterans’ Affairs to complete a publicly available review of the deaths of all veterans who died by suicide during the preceding five years.  The review would include a list of all medications prescribed to, and found in the system of, such veterans at the time of their deaths.

On March 7, the bill was sent to the Subcommittee on Health.  It will be interesting to watch its progress or lack thereof.  It will be interesting to see if politicians have more courage to buck their pharma paymasters than psychiatrists.  They certainly couldn’t have less.

19 COMMENTS

  1. Regarding “… cause a lot of people to stop taking their medications.”
    Don’t you worship the holy molecules of science that can only do good? ( joking)

    T. Szasz wrote that people are moral agents , responsible for their actions.
    That neither the pro-drug psychiatrists or the anti-drug psychiatrists treats the patient-subject as a responsible moral agent.

    I having willing and unwilling consumed the psychiatric drugs, know the drugs can affect the mind. That is the drugs design-intent.

    A person can not be a moral agent when under the influence of drugs ( or withdrawing from).
    And they call out for more DRUGS.

    “2: we need to find other drugs that work on other systems and parts of the brain” Dr. Nancy C. Andreasen

    http://www.nytimes.com/2008/09/16/health/research/16conv.html

  2. Would it be relevant – (if still technically possible) – to undertake CYP 450 genomic sequencing on residual tissue?
    CYP 2C9, CYP2C19, CYP2D6, and possibly other genomic variants adversely affect the metabolic breakdown of SSRI’s – SNRI”s and other psycholeptic drugs. If the “Wings” tragedy might be further clarified by genomic sequencing, potentially identifying metabolic vulnerability to akathisia, then surely that forensic investigation should be mandatory?
    If there was an increased CYP 450 genetic predisposition to exacerbated prescription-drug induced suicidality and homicidality, via immediately preceding multiple psychiatric “medication”, this co-pilot may not have been in a position to exercise choice in the presumed “decision” to undertake those actions currently described as “murder- suicide”. Such forensic evidence may indicate that the crime could not or should not be attributed to the co-pilot. This comment fully acknowledges the indescribable terror and suffering of all those on board.

    Ref. Lucire Y. Crotty C. Antidepessant-induced akathisia-related homicides associated with diminishing mutations in the metabolising genes of the CYP 450 family.
    Pharmgenomics Pers Med 2011;4: 65 – 81.

    • Drtim,

      It’s an interesting question. If a person drinks alcohol, and then commits a murder, he is held legally responsible for the murder, on the grounds that he should reasonably have known that alcohol can markedly influence our actions. But if a person takes pills prescribed by a physician, he has a reasonable expectation that the drugs are safe. I don’t think that we – as a society – have come to terms with this issue yet. For the Germanwings pilot, however, the issue is moot, because he was required – by the conditions of his license – to let his employer know if he resumed taking antidepressant drugs.

      • Thank you for clarifying the professional duty regarding medication disclosure. However, should this man have been suffering form severe psycholeptic prescription drug induced akathisia:-
        1) It would seem extremely unlikely that the prescriber would have warned him about the risk, nature of and potential consequences of akathisia.
        2) It is possible that he may ( or may not) have had a metabolic vulnerability to akathisia which may still be possible to identify or exclude within the limits of current CYP 450 genomic sequencing methodology.
        3) If this mans actions were determined not by choice but by prescription drug induced akathisia, then he may have been too intensely akathisic to be able to inform his employer of the medication he was (believed to be) taking.
        4) Just assume that 1) —-> 3) accurately define this pre “murder-suicide’ event, is it
        appropriate that the prescriber is exonerated from any contributory action/s?

        Finally, it might be argued that he could have told the employer before the onset of (possible) akathisia. Had there been extreme CYP 450 genomic variant vulnerability to serotonin and other neurotransmitter rapidly accumulating in the brain and other tissue with overwhelming toxicity, the onset may have occurred whilst not flying or expecting immediately to fly. Subsequent actions and decisions MAY not have been the choices which would have been made in the absence of (possible) intense ADR’s.
        I am uncomfortable speculating in a case where the scale, intensity and duration of suffering of all souls on board, and the suffering of all their loved ones is almost beyond comprehension.
        There does seem to be a question of accuracy and interpretation of coronial and/or other forms of inquiry into suicide, murder-suicide, and mass murder events where the person or persons responsible may not have acted in such a manner unless suffering from akathisia induced by prescription psychiatric medication. If their actions are entirely compelled by drug toxicity overwhelming any decision process, or their actions are entirely drug induced compulsions, then surely it is necessary to routinely apply all of the (real) science available to truly understand and to begin effective prevention?

        • Drtim, it might be wise to also examine the “brainstem 5-HT1A and 2A receptors,” since he may have been suffering from serotonin syndrome, according to the drug interaction warnings, of the drugs he was given.

          And I don’t doubt the antidepressants can cause akathisia, so do find it odd that isn’t listed as one of the possible symptoms of serotonin syndrome in drugs.com. But I do hope the medical community as a whole starts looking more at drug interaction websites, rather than just speculating about cases. Perhaps you could pass this advise on to other doctors, please?

          • Thank you. As you know, I am not a psychiatrist but I would conceptualise that akathisia is vital to recognise and manage fastidiously as it may be the first presenting feature of a life threatening serotonin syndrome. Having seen intense akathisia “professionally DSM /ICD 10 diagnosed” as “psychotic depression”, with absolute refusal to reconsider a differential diagnosis, and insistence on compulsory “treatment” with fluoxetine and olanzapine – I am truly astonished at the apparent lack of medical awareness of this dreadful ADR.
            This seems relevant to both primary and secondary care physicians? Perhaps A + E specialists may be more diagnostically aware? That is an unknown to me, but it would seem possible,
            I find doctors receptive to my concerns in primary care.
            Perhaps the real medical educational issue is why this appears to be a “best kept secret” in our training?
            I am now a retired physician and have the time available to try to write and alert others to those concerns.

          • Drtim, I’d be very grateful if you’d consider writing to other doctors regarding the importance of checking for drug interactions.

            What particularly concerns me is that today’s “bipolar” drug cocktail recommendations suggest combining the antidepressants and the antipsychotics, despite the fact that combining these drug classes should already be known to cause anticholinergic toxidrome (see my comment below).

            And this may have been what your patient prescribed the fluoxetine and olanzapine was dealing with. I’ve written to the Mayo and asked that they change the “bipolar” drug recommendations, to no avail. Perhaps they’d consider doing it, if the suggestion came from a doctor?

      • Not wrong. What I mean is they are not going to do anything to restrict/limit the massive overuse of these drugs or to provide more clear warnings of the dangers.

        Realistically, psychiatry is not a priority or an area of knowledge for the overwhelming majority of politicians. They don’t have the time or interest to educate themselves about this field. All they know is that at some point in time they are getting money from some lobbyist telling nice-sounding (if mostly false) things about psychiatric diagnoses and drugs, and so they are going to vote to do what that lobbyist wants without investigating the issue.

        But again that is probably less than 1% of their time, which is mostly spent legislating other matters. Psychiatry is not a big deal to most politicians relative to issues like taxes, jobs, trade, the overall state of the economy, the military, and even shiny objects like guns, marijuana or gay marriage.

        How much is policy on psychiatric drugs in the mainstream news? Hardly at all.

  3. If the co-pilot had been prescribed antidepressants, plus antipsychotics, as you seem to indicate. This should technically be a case of known drug poisoning, since combining those classes of drugs is already medically known to make a person “mad as a hatter,” via anticholinergic toxidrome.

    “Substances that may cause this toxidrome include the four ‘anti’s of antihistamines, antipsychotics, antidepressants, and antiparkinsonian drugs[3] as well as atropine, benztropine, datura, and scopolamine.”

    These are the central symptoms of neuroleptic induced anticholinergic intoxication syndrome, from drugs.com:

    “Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

    And plugging as many of the drugs the copilot was put on, as possible, into the drugs.com interaction checker (not including the antipsychotic, Dominal, and the zopiclone, since these drugs are not listed in that website’s drugs). You do get 3 major drug interaction warnings, and 7 moderate drug interaction warnings – including warnings of serotonin syndrome. This is one of the major drug interaction warnings:

    “Concomitant use of agents with serotonergic activity … may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.”

    It strikes me that the prescribing doctors / psychiatrists should likely be the ones held morally and legally responsible for that airline crash, given the drug interaction warnings for the drugs the co-pilot was given.

    • “… these drugs are safe when ‘properly prescribed,'” maybe, but there seems to be a huge societal problem, resulting from many of the psychiatrists not knowing how to prescribe the drugs safely. If one of their drugs doesn’t work, the psychiatrists put the patient on six or seven drugs, to cover up their prior iatrogenesis and the ineffective nature of their drugs.

      • I would imagine so, and even just inputting, into drugs.com, the three drugs found in the pilot’s system at the time of death – the citalopram, mirtazapine, and zopiclone – this drug cocktail does have a major drug interaction warning for serotonin syndrome.

        I do so hope the psychiatrists, and mainstream doctors supporting them, grow up soon, and confess the psychiatric drugs are toxic torture drugs. And massively drugging everyone who reacts badly to one psychiatric drug, to protect the reputation of the drugs and psychiatry, is appallingly immoral behavior.

        I hope the doctors and psychiatrists who mis”medicated” the pilot are held accountable for their mis”medication” of him, and the deaths related to this medical malpractice. The psychiatric insanity needs to end.

  4. I cannot speak for how pilots license are issued in Germany but as a former private pilot I can tell you about the US.

    The medical screening when it comes to drugs for pilots is a JOKE! When I was flying I needed what is called a 3rd class medical certificate. This requires passing a physical and vision exam given by an FAA approved doctor. In my area, there are about 12 such certified doctors. I had to provide the doctor, who never saw me before, with a list of medications. I wasn’t on anti-depressants at the time so there was no issue. IF I was I could have easily left them off the list and the doctor would not have known. There was NO requirement for the FAA doctor to validate my medications with my main doctor.
    When I started to take anti-depressants I voluntarily let my medical certificate expire and did not renew it. This means I was unable to renew my pilots license and i could only fly when a flight instructor was in the plane at the controls next to me. I could have easily lied to the FAA doctor and kept on flying.

    I am not at all surprised this pilot was able to keep flying even though he was on several drugs that should have kept him on the ground.

  5. Hi Dr Hickey.
    I know in my State the Mental Health portfolio is seen as a ‘black hole’ which is used to dispose of any corrupt acts committed by doctors and public servants, thus ensuring that the matters never see the light of day where they truly belong, in the criminal courts. Our Minister has been derelict in her duty for the whole time she has been in office enabling this corruption.
    Now that an election is approaching, she falls on her sword, the parliamentary secretary with knowledge of where the bodies are takes the reigns, and pleads ignorance to the public should any of those bodies surface during the campaign.
    All good though, coz the other team is doing the same.

    • I placed a set of fraudulent documents provided by a hospital to my lawyers, authorised by the Clinical Dicrector in front of the Minister for Police parliamentary secretary. The documents proving a number of serious criminal offenses removed, and slanderous documents inserted in their place. At the time this was to be referred to our Attorney General for investigation, and a response within 3 weeks. Instead the matter gets referred to Minister fo MH and not a peep in more than a year and a half.
      I guess if a Clinical Director can authorise such sets of documents to conceal kidnappings and criminal conspiracies, and the authorities will simply fail to act even when the proof is available, and those involved are full aware of their crimes but are instructed to remain silent, then what chance does anyone have if targeted by these thugs.

  6. Flying while on lorazepam, ambien, and dominal is just crazy. Isn’t dominal in the same medication class as Thorazine??? Also, I don’t think a pilot should be ever prescribed benzodiazepines or z-drugs. These are unsafe even when driving a car, let alone flying….

    Suddenly, we’re on this antidepressant crusade, while forgetting how much more dangerous those GABAergic drugs are….